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Canton SP, Austin CN, Steuer F, Dadi S, Sharma N, Kass NM, Fogg D, Clayton E, Cunningham O, Scott D, LaBaze D, Andrews EG, Biehl JT, Hogan MV. Feasibility and Usability of Augmented Reality Technology in the Orthopaedic Operating Room. Curr Rev Musculoskelet Med 2024; 17:117-128. [PMID: 38607522 PMCID: PMC11068703 DOI: 10.1007/s12178-024-09888-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Augmented reality (AR) has gained popularity in various sectors, including gaming, entertainment, and healthcare. The desire for improved surgical navigation within orthopaedic surgery has led to the evaluation of the feasibility and usability of AR in the operating room (OR). However, the safe and effective use of AR technology in the OR necessitates a proper understanding of its capabilities and limitations. This review aims to describe the fundamental elements of AR, highlight limitations for use within the field of orthopaedic surgery, and discuss potential areas for development. RECENT FINDINGS To date, studies have demonstrated evidence that AR technology can be used to enhance navigation and performance in orthopaedic procedures. General hardware and software limitations of the technology include the registration process, ergonomics, and battery life. Other limitations are related to the human response factors such as inattentional blindness, which may lead to the inability to see complications within the surgical field. Furthermore, the prolonged use of AR can cause eye strain and headache due to phenomena such as the vergence-convergence conflict. AR technology may prove to be a better alternative to current orthopaedic surgery navigation systems. However, the current limitations should be mitigated to further improve the feasibility and usability of AR in the OR setting. It is important for both non-clinicians and clinicians to work in conjunction to guide the development of future iterations of AR technology and its implementation into the OR workflow.
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Affiliation(s)
- Stephen P Canton
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA.
| | | | - Fritz Steuer
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Srujan Dadi
- Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA
| | - Nikhil Sharma
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicolás M Kass
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Fogg
- Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Elizabeth Clayton
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Onaje Cunningham
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Devon Scott
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Dukens LaBaze
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA
| | - Edward G Andrews
- Department of Neurological Surgery University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jacob T Biehl
- School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Pittsburgh, PA, 15213, USA
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Sharma N, Mallela AN, Khan T, Canton SP, Kass NM, Steuer F, Jardini J, Biehl J, Andrews EG. Evolution of the meta-neurosurgeon: A systematic review of the current technical capabilities, limitations, and applications of augmented reality in neurosurgery. Surg Neurol Int 2024; 15:146. [PMID: 38742013 PMCID: PMC11090549 DOI: 10.25259/sni_167_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
Background Augmented reality (AR) applications in neurosurgery have expanded over the past decade with the introduction of headset-based platforms. Many studies have focused on either preoperative planning to tailor the approach to the patient's anatomy and pathology or intraoperative surgical navigation, primarily realized as AR navigation through microscope oculars. Additional efforts have been made to validate AR in trainee and patient education and to investigate novel surgical approaches. Our objective was to provide a systematic overview of AR in neurosurgery, provide current limitations of this technology, as well as highlight several applications of AR in neurosurgery. Methods We performed a literature search in PubMed/Medline to identify papers that addressed the use of AR in neurosurgery. The authors screened three hundred and seventy-five papers, and 57 papers were selected, analyzed, and included in this systematic review. Results AR has made significant inroads in neurosurgery, particularly in neuronavigation. In spinal neurosurgery, this primarily has been used for pedicle screw placement. AR-based neuronavigation also has significant applications in cranial neurosurgery, including neurovascular, neurosurgical oncology, and skull base neurosurgery. Other potential applications include operating room streamlining, trainee and patient education, and telecommunications. Conclusion AR has already made a significant impact in neurosurgery in the above domains and has the potential to be a paradigm-altering technology. Future development in AR should focus on both validating these applications and extending the role of AR.
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Affiliation(s)
- Nikhil Sharma
- School of Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Arka N. Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, United States
| | - Talha Khan
- Department of Computing and Information, University of Pittsburgh, Pittsburgh, United States
| | - Stephen Paul Canton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, United States
| | | | - Fritz Steuer
- School of Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Jacquelyn Jardini
- Department of Biology, Haverford College, Haverford, Pennsylvania, United States
| | - Jacob Biehl
- Department of Computing and Information, University of Pittsburgh, Pittsburgh, United States
| | - Edward G. Andrews
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, United States
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Sharma N, Head JR, Mallela AN, Shanahan RM, Canton SP, Abou-Al-Shaar H, Kass NM, Steuer F, Cheng L, Raver M, Andrews EG. Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy. Surg Neurol Int 2024; 15:67. [PMID: 38468651 PMCID: PMC10927197 DOI: 10.25259/sni_894_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024] Open
Abstract
Background The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus is one of the most common life-saving procedures that neurosurgeons perform worldwide. There are many well-known complications associated with EVD placement, including tract hemorrhages, intra-parenchymal and subdural hemorrhages, infection, and catheter misplacement. Given the variety of complications associated with EVD placement and the inconsistent findings on the relationship of accuracy to complications, the present study reviewed short- and long-term complications related to EVD placement at our institution. Methods A retrospective review was conducted for all consecutive patients who underwent bedside EVD placement for any indication between December 2020 and December 2021. Collected variables included demographic information, etiology of disease state, pre-and post-operative head computed tomography measurements, and post-procedural metrics (immediate and delayed complications). Results A total of 124 patients qualified for inclusion in our study. EVDs that were non-functioning/exchanged were not significantly related to age, accuracy, ventriculomegaly, sex, disposition, laterality, type of EVD used, intraventricular hemorrhage (IVH), etiology, or Kakarla Grade (KG) (all P > 0.17). The need for a second EVD was similarly not related to age, accuracy, ventriculomegaly, sex, disposition, location, laterality, type of EVD used, IVH, etiology, or KG (all P > 0.130). Patients who died, however, were significantly more likely to have a second contralateral EVD placed (18.2% vs. 4.9% P = 0.029). We also found that left-sided EVDs were significantly more likely to fail within seven days of placement (29.4% vs 13.3%, P = 0.037; relative risk (RR) 1.93, 95% confidence interval: 1.09-3.43), unrelated to age, sex, etiology, type of EVD, IVH, location of the procedure, or accuracy (all P > 0.07). This remained significant when using a binary logistic regression to control for ventriculomegaly, accuracy, mortality, age, sex, and etiology (P = 0.021, B = 3.43). Conclusion In our cohort, although a clear relationship between inaccuracy and complication rates was not found, our data did demonstrate that left-sided EVDs were more likely to fail within the immediate postoperative time point, and patients who died were more likely to have a second, contralateral EVD placed.
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Affiliation(s)
- Nikhil Sharma
- School of Medicine, University of Pittsburgh, Pennsylvania, United States
| | - Jeffery R. Head
- Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States
| | - Arka N. Mallela
- Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States
| | - Regan M. Shanahan
- School of Medicine, University of Pittsburgh, Pennsylvania, United States
| | - Stephen P. Canton
- Department of Orthopaedic Surgery Pittsburgh, Pennsylvania, United States
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States
| | | | - Fritz Steuer
- School of Medicine, University of Pittsburgh, Pennsylvania, United States
| | - Lucille Cheng
- School of Medicine, University of Pittsburgh, Pennsylvania, United States
| | - Michael Raver
- School of Medicine, University of Pittsburgh, Pennsylvania, United States
| | - Edward G. Andrews
- Department of Neurosurgery, University of Pittsburgh, Medical School, Pennsylvania, United States
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Adida S, Legarreta A, Hudson JS, Kumar RP, Kass NM, Agarwal N, Gerszten PC, Andrews EG. Application of Machine Learning for Automatic Segmentation of Paraspinal Musculature. World Neurosurg 2023; 180:228-230. [PMID: 37940447 DOI: 10.1016/j.wneu.2023.10.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Samuel Adida
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew Legarreta
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Joseph S Hudson
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rohit P Kumar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nicolás M Kass
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Peter C Gerszten
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edward G Andrews
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Khan T, Zhu TS, Downes T, Cheng L, Kass NM, Andrews EG, Biehl JT. Understanding Effects of Visual Feedback Delay in AR on Fine Motor Surgical Tasks. IEEE Trans Vis Comput Graph 2023; 29:4697-4707. [PMID: 37788206 DOI: 10.1109/tvcg.2023.3320214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Latency is a pervasive issue in various systems that can significantly impact motor performance and user perception. In medical settings, latency can hinder surgeons' ability to quickly correct movements, resulting in an experience that doesn't align with user expectations and standards of care. Despite numerous studies reporting on the negative effects of latency, there is still a gap in understanding how it impacts the use of augmented reality (AR) in medical settings. This study aims to address this gap by examining how latency impacts motor task performance and subjective perceptions, such as cognitive load, on two display types: a monitor display, traditionally used inside an operating room (OR), and a Microsoft HoloLens 2 display. Our findings indicate that both level of latency and display type impact motor performance, and higher latencies on the HoloLens result in relatively poor performance. However, cognitive load was found to be unrelated to display type or latency, but was dependent on the surgeon's training level. Surgeons did not compromise accuracy to gain more speed and were generally well aware of the latency in the system irrespective of their performance on task. Our study provides valuable insights into acceptable thresholds of latency for AR displays and proposes design implications for the successful implementation and use of AR in surgical settings.
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Patel A, Abdelsalam A, Shariff RK, Mallela AN, Andrews EG, Tonetti DA, Lunsford LD, Abou-Al-Shaar H. Bibliometric analysis of the top 100 cited articles on stereotactic radiosurgery of intracranial meningiomas. Br J Neurosurg 2023; 37:1088-1093. [PMID: 35142245 DOI: 10.1080/02688697.2022.2034745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/23/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sterotactic radiosurgery is becoming an integral modality in the management of intracranial meningiomas, both as the primary treatment or as adjuvant therapy. This study analyzes the scholarly impact of the top 100 cited articles on the stereotactic radiosurgical management of intracranial meningiomas. METHODS A ranked list of the 100 most-cited articles was generated using the Scopus database by searching the keywords 'intracranial meningioma' and 'stereotactic radiosurgery'. All articles were then evaluated on multiple criteria regarding both the publication of the articles (year of publication, journal, country of origin, and authors) as well as their methods and foci (type of study, location of studied meningiomas, and type of radiosurgical modality). Quantitaitve and qualitative analyses were then performed from the collected data. RESULTS The most frequently cited articles on stereotactic radiosurgical management of intracranial meningiomas were published between 1990 and 2016. The average citation-per-year across all papers in the list was 6.1. The most studied anatomic area of intracranial meningiomas was the skull base, with the cavernous sinus being the most well-studied specific site. The most utilized stereotactic radiosurgical modality was Gamma Knife radiosurgery. The country with the highest number of publications was the United States. Twenty-six percent of the articles were published in the journal Neurosurgery; Lunsford, Kondziolka, Flickinger, Sheehan, and Pollock were respectively the most frequent listed authors among this list. The most active academic institute publishing on this topic was the University of Pittsburgh Medical Center. CONCLUSION Stereotactic radiosurgery is an integral modality in the management of intracranial meningiomas. This bibliometric analysis sheds the light on the ways in which intracranial meningiomas have been studied in the past two decades in order to identify trends among neurosurgeons and radiation oncologists and to reveal areas of rising and declining focus.
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Affiliation(s)
- Aneek Patel
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Ahmed Abdelsalam
- Department of Neurology, Saint Louis University Hospital, St. Louis, MO, USA
| | - Rimsha K Shariff
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward G Andrews
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel A Tonetti
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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7
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Andrews EG, Hect JL, Mittal AM, Nowicki KW, Agarwal V, Gerszten PC. Tetra-compartmental spinal infection with conus medullaris syndrome: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22447. [PMID: 36748756 PMCID: PMC10550562 DOI: 10.3171/case22447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Recent literature suggests that spinal infections are increasing in prevalence. Any compartment can be infected in the spine; however, multicompartmental infections are rare. OBSERVATIONS To the authors' knowledge, this report is the only reported case of a tetra-compartmental spinal infection consisting of epidural, subdural, subarachnoid, and intramedullary components with a contiguous lumbar spondylodiscitis resulting in conus medullaris syndrome requiring surgical intervention. LESSONS This case highlights the importance of surgical intervention in severe cases such as the one illustrated in this report. Second, magnetic resonance imaging with and without contrast is required to check for spreading of the infection as these findings may change the surgical approach. Last, the use of intraoperative ultrasound is paramount to evaluate the subdural and intramedullary compartments in severe cases.
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Affiliation(s)
| | | | | | | | - Vikas Agarwal
- Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Mittal AM, Andrews EG, Nowicki KW, Wecht DA, Agarwal V, Monaco EA. Arachnoid webs causing rostral syrinx due to ball-valve effect: an illustrative report of two cases. Br J Neurosurg 2023:1-6. [PMID: 36636902 DOI: 10.1080/02688697.2022.2154749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/17/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
An arachnoid web is a pathological formation of the arachnoid membrane. It is a rare phenomenon but is known to lead to syrinx formation in the spinal cord along with pain and neurological deficits. On imaging, the 'scalpel sign' is pathognomonic for an arachnoid web. The etiology of syrinx formation from an arachnoid web is currently unknown. This report documents the only two cases of arachnoid webs with an extensive syrinx in which a likely pathophysiologic mechanism is identified. Both cases presented with motor deficits. The patients had no history of trauma or infection. After extensive workup in both patients and observation of the scalpel sign an arachnoid web was suspected. In both cases, the patients were treated surgically after an arachnoid web was suspected. Intra-operative ultrasound visualized in both cases demonstrates a fenestration in the web that allowed passage of cerebrospinal fluid in a rostral-caudal direction due to a ball-valve effect.
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Affiliation(s)
- Aditya M Mittal
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward G Andrews
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kamil W Nowicki
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel A Wecht
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vikas Agarwal
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Edward A Monaco
- Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Danville, PA, USA
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Deng H, Habib A, Andrews EG, Zhang X, McCarthy DJ, Wei Z, Dhupar R, Choudry MH, Zinn PO. Combined exploratory laparotomy, transpsoas, and thoracic approach to resection of a giant spinal ganglioneuroma: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22453. [PMID: 36624632 PMCID: PMC9830412 DOI: 10.3171/case22453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ganglioneuromas are rare peripheral nervous system tumors of neural crest origin. Most are often asymptomatic and incidentally found, but large tumors can cause mass effect. Herein, the authors report a case of a giant ganglioneuroma that arose from the lumbar foramina into the retroperitoneal and thoracic cavities. OBSERVATIONS A 62-year-old female presented with low back pain, left lower extremity swelling, and increased sensation of an abdominal mass. Surgical treatment options were reviewed with the patient and coordinated care was planned by surgical oncological specialists. The patient opted for multistage exploratory laparotomy for abdominal mobilization, diaphragm resection, and en bloc resection with neuromonitoring. After surgery, the patient experienced significant improvement in symptoms. LESSONS A combined surgical exposure involving gastrointestinal, thoracic, and neurological surgeons can be important in the safe resection of ganglioneuromas that span multiple body cavities. Hence, a thorough preoperative assessment could help plan surgery accordingly.
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Affiliation(s)
- Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmed Habib
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | - Edward G. Andrews
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xiaoran Zhang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David J. McCarthy
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Zhishuo Wei
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - M. Haroon Choudry
- Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pascal O. Zinn
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
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Khan T, Biehl JT, Andrews EG, Babichenko D. A systematic comparison of the accuracy of monocular RGB tracking and LiDAR for neuronavigation. Healthc Technol Lett 2022; 9:91-101. [PMID: 36514478 PMCID: PMC9731545 DOI: 10.1049/htl2.12036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 12/16/2022] Open
Abstract
With the advent of augmented reality (AR), the use of AR-guided systems in the field of medicine has gained traction. However, the wide-scale adaptation of these systems requires highly accurate and reliable tracking. In this work, the tracking accuracy of two technology platforms, LiDAR and Vuforia, are developed and rigorously tested for a catheter placement neurological procedure. Several experiments (900) are performed for each technology across various combinations of catheter lengths and insertion trajectories. This analysis shows that the LiDAR platform outperformed Vuforia; which is the state-of-the-art in monocular RGB tracking solutions. LiDAR had 75% less radial distance error and 26% less angle deviation error. Results provide key insights into the value and utility of LiDAR-based tracking in AR guidance systems.
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Affiliation(s)
- Talha Khan
- School of Computing and InformationUniversity of PittsburghPittsburghPAUSA
| | - Jacob T. Biehl
- School of Computing and InformationUniversity of PittsburghPittsburghPAUSA
| | - Edward G. Andrews
- Department of Neurological SurgerySchool of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Dmitriy Babichenko
- School of Computing and InformationUniversity of PittsburghPittsburghPAUSA
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Gibby W, Cvetko S, Gibby A, Gibby C, Sorensen K, Andrews EG, Maroon J, Parr R. The application of augmented reality-based navigation for accurate target acquisition of deep brain sites: advances in neurosurgical guidance. J Neurosurg 2022; 137:489-495. [PMID: 34920422 DOI: 10.3171/2021.9.jns21510] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study is to quantify the navigational accuracy of an advanced augmented reality (AR)-based guidance system for neurological surgery, biopsy, and/or other minimally invasive neurological surgical procedures. METHODS Five burr holes were drilled through a plastic cranium, and 5 optical fiducials (AprilTags) printed with CT-visible ink were placed on the frontal, temporal, and parietal bones of a human skull model. Three 0.5-mm-diameter targets were mounted in the interior of the skull on nylon posts near the level of the tentorium cerebelli and the pituitary fossa. The skull was filled with ballistic gelatin to simulate brain tissue. A CT scan was taken and virtual needle tracts were annotated on the preoperative 3D workstation for the combination of 3 targets and 5 access holes (15 target tracts). The resulting annotated study was uploaded to and launched by VisAR software operating on the HoloLens 2 holographic visor by viewing an encrypted, printed QR code assigned to the study by the preoperative workstation. The DICOM images were converted to 3D holograms and registered to the skull by alignment of the holographic fiducials with the AprilTags attached to the skull. Five volunteers, familiar with the VisAR, used the software/visor combination to navigate an 18-gauge needle/trocar through the series of burr holes to the target, resulting in 70 data points (15 for 4 users and 10 for 1 user). After each attempt the needle was left in the skull, supported by the ballistic gelatin, and a high-resolution CT was taken. Radial error and angle of error were determined using vector coordinates. Summary statistics were calculated individually and collectively. RESULTS The combined angle of error of was 2.30° ± 1.28°. The mean radial error for users was 3.62 ± 1.71 mm. The mean target depth was 85.41 mm. CONCLUSIONS The mean radial error and angle of error with the associated variance measures demonstrates that VisAR navigation may have utility for guiding a small needle to neural lesions, or targets within an accuracy of 3.62 mm. These values are sufficiently accurate for the navigation of many neurological procedures such as ventriculostomy.
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Affiliation(s)
- Wendell Gibby
- 1Department of Radiology, University of California, San Diego, California
- 2Novarad, American Fork, Utah
- 3Blue Rock Medical, Provo, Utah; and
| | | | | | | | | | - Edward G Andrews
- 4Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joseph Maroon
- 4Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Muthiah N, Nowicki KW, Picarsic JL, D’Angelo MP, Marker DF, Andrews EG, Monaco EA, Niranjan A. Three decades of progress from surgery to medical therapy for isolated neuroaxis BRAF V600E–positive Langerhans cell histiocytosis management: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2118. [PMID: 35854832 PMCID: PMC9245772 DOI: 10.3171/case2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
“Langerhans cell histiocytosis” (LCH) is a term that encompasses single-system or multisystem disorders traditionally characterized by a proliferation of clonal CD1a+/CD207+ myeloid-derived histiocytes. In most cases of LCH, mitogen-activated protein kinase (MAPK) pathway somatic mutations lead to near universal upregulation of phosphorylated extracellular signal-regulated kinase expression. The clinical manifestations of LCH are numerous, but bone involvement is common. Intracranial lesions, especially as isolated manifestations, are rare.
OBSERVATIONS
The authors presented the case of a long-term survivor of exclusive intracranial LCH that manifested with isolated craniofacial bone and intraparenchymal central nervous system recurrences, which were managed with 3 decades of multimodal therapy. The patient was initially diagnosed with LCH at age 2 years, and the authors documented the manifestations of disease and treatment for 36 years. Most of the patient’s treatment course occurred before the discovery of BRAF V600E. Treatments initially consisted of chemotherapy, radiosurgery, and open resections for granulomatous LCH lesions. Into young adulthood, the patient had a minimal disease burden but still required additional radiosurgical procedures and open resections.
LESSONS
Surgical treatments alleviated the patient’s immediate symptoms and allowed for tumor burden control. However, surgical interventions did not cure the underlying, aggressive disease. In the current era, access to systemic MAPK inhibitor therapy for histiocytic lesions may offer improved outcomes.
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Affiliation(s)
| | | | - Jennifer L. Picarsic
- Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Michael P. D’Angelo
- Department of Cardiothoracic Surgery, New York University Langone School of Medicine, New York, New York; and
| | - Daniel F. Marker
- Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Edward A. Monaco
- Department of Neurological Surgery, Geisinger Commonwealth School of Medicine, Danville, Pennsylvania
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Tonetti DA, Andrews EG, Stabingas K, Tyler-Kabara E, Gross BA, Jadhav A. Posterior Communicating Artery Giving Rise to Shared-Origin Anterior Choroidal Artery: Case Illustration. World Neurosurg 2017; 109:413-415. [PMID: 29111473 DOI: 10.1016/j.wneu.2017.10.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The origin point of the anterior choroidal artery (AChA) is variable, typically arising from the supraclinoid internal carotid artery (ICA) distal to the posterior communicating artery (PComA) on either the posterolateral or posterior aspect of the ICA. Variations of AChA origin have important clinical implications, and rare origins reported previously include the ICA bifurcation and middle cerebral artery. We provide illustrations of a case of a shared-origin PComA and AChA. CASE DESCRIPTION A young girl presented with intracranial hemorrhage and underwent angiography to evaluate for an underlying cause. Ultimately, 3-dimensional rotational angiography incidentally demonstrated a common origin of the AChA with the PComA. CONCLUSIONS A rare case of a shared-origin AChA and PComA is reported for angiographic illustration. The radiologic findings, embryology behind the development of the AChA, and neurosurgical and neurovascular relevance of this variant are discussed. The importance of recognizing the origin of the AChA is emphasized.
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Affiliation(s)
- Daniel A Tonetti
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Edward G Andrews
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kristen Stabingas
- Department of Neurological Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Tyler-Kabara
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashutosh Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Harshyne LA, Hooper KM, Andrews EG, Nasca BJ, Kenyon LC, Andrews DW, Hooper DC. Glioblastoma exosomes and IGF-1R/AS-ODN are immunogenic stimuli in a translational research immunotherapy paradigm. Cancer Immunol Immunother 2015; 64:299-309. [PMID: 25391690 PMCID: PMC11029437 DOI: 10.1007/s00262-014-1622-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 10/04/2014] [Indexed: 01/16/2023]
Abstract
Glioblastomas are primary intracranial tumors for which there is no cure. Patients receiving standard of care, chemotherapy and irradiation, survive approximately 15 months prompting studies of alternative therapies including vaccination. In a pilot study, a vaccine consisting of Lucite diffusion chambers containing irradiated autologous tumor cells pre-treated with an antisense oligodeoxynucleotide (AS-ODN) directed against the insulin-like growth factor type 1 receptor was found to elicit positive clinical responses in 8/12 patients when implanted in the rectus sheath for 24 h. Our preliminary observations supported an immune response, and we have since reopened a second Phase 1 trial to assess this possibility among other exploratory objectives. The current study makes use of a murine glioma model and samples from glioblastoma patients in this second Phase 1 trial to investigate this novel therapeutic intervention more thoroughly. Implantation of the chamber-based vaccine protected mice from tumor challenge, and we posit this occurred through the release of immunostimulatory AS-ODN and antigen-bearing exosomes. Exosomes secreted by glioblastoma cultures are immunogenic, eliciting and binding antibodies present in the sera of immunized mice. Similarly, exosomes released by human glioblastoma cells bear antigens recognized by the sera of 6/12 patients with recurrent glioblastomas. These results suggest that the release of AS-ODN together with selective release of exosomes from glioblastoma cells implanted in chambers may drive the therapeutic effect seen in the pilot vaccine trial.
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Affiliation(s)
- Larry A Harshyne
- Department of Neurological Surgery, Thomas Jefferson University, 1020 Locust St, rm 454, Philadelphia, PA, 19107, USA,
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